Predictors of outcome in myxoedema coma

Abstract

Myxoedema coma is a rare and life-threatening illness the outcome of which has not been robustly studied in large numbers, partly due to its low incidence. Dutta and colleagues have explored outcome predictors in a developing country where access to thyroid function tests is more limited than in the Western world. Cardiovascular instability, reduced consciousness, persistent hypothermia, and sepsis all contributed to a poorer outcome, as has been demonstrated before, but a generic outcome predictor model was shown to be useful in this group of patients. Unfortunately, this observational study was unable to show differences in outcome based on replacement treatment methods and the mortality remains at 40%.

Guidelines for the Treatment of Hypothyroidism: Prepared by the American Thyroid Association Task Force on Thyroid Hormone Replacement

“…Use of intravenous L-T3 monotherapy administered at doses of either 25 or 50 mcg daily in hypothyroid patients with serum TSH values in the range of 68-81 mIU/L lead to normalization of various cardiovascular, pulmonary, metabolic parameters within a week(605). TSH values decreased significantly within the same time period, although less so than the TSH response to intravenous L-T4 observed by the same authors in a similar cohort of patients(604).Given the rarity of myxedema coma, randomized clinical trials are not feasible, and so recommendations regarding the type, route, and outcomes measures for replacement are based solely on expert opinion and case reports(595,599,(606)(607)(608)(609)(610)(611)(612)(613)(614)(615)(616)(617)(618)(619). In addition to aggressive thyroidPage 122 of 207 Thyroid GUIDELINES FOR THE TREATMENT OF HYPOTHYROIDISM (doi: 10.1089/thy.2014.0028)…”

Amiodarone-induced myxoedema coma as a rare differential diagnosis of consciousness disturbance

“…[13] Thyroid hormone replacement therapy is the cornerstone of treatment, as well as supportive measures and management of concomitant or precipitating disorders. The best thyroid hormone replacement therapy in MC remains a controversial area, due to lack of studies and evident difficulties in performing controlled trials.…”

Myxoedema coma in the setting of hyperglycaemic hyperosmolar state

“…Treatment defaulters are also likely to have more severe hypothyroidism with higher mortality rates compared to de novo presentations, however, the aetiology of hypothyroidism has not been shown to influence outcomes. The Sequential Organ Failure Assessment has also been shown to be effective in predicting mortality 5 6…”